KPT, Postfach, CH-3001 Bern

kpt.ch

Voluntary Health Insurance (F)

Special conditions supplementary to the GCI
Edition of 01.2006

Contract

Purpose F art. 1
We insure individuals who transfer their legal domicile from Switzerland to another country by means of
Voluntary Health Insurance. The insurance is offered on condition that invoices (for premiums, participa-
tion in costs) are paid by direct debit.

Annual fixed charge (deductible) F art. 2

1 The full annual fixed charge (deductible) chosen by the insured is due even for contracts running for

less than one year.

2 On completion of the 18th year of age the minimum annual fixed charge is CHF 300.–.
3 You may opt for a higher annual deductible (excess) at the beginning of the following calendar year.
4 The higher annual deductible may be reduced or annulled at the end of the year while observing a

3-month period of notice. We are then entitled to carry out a risk analysis.

Benefits

Table of benefits F art. 3

In-patient treatment Per day 1 to 90 days 90 to 180 days 181 to 720 days

Hospitalisation CHF 600.– CHF 300.– CHF 100.–

Psychiatry / CHF 600.– CHF 100.–
Psychotherapy
Nursing homes CHF 50.–
Medical CHF 300.–, for a maximum of 60 days within 5 calendar
rehabilitation years.
Out-patient Medical 90 % of costs.
treatment not treatment
prescribed by
Psychotherapy / 90 % of costs, maximum CHF 3,000.– per calendar year.
a doctor
Psychiatry
Chiropractor 90 % of costs, maximum 24 sessions per calendar year.
Midwife 90 % of costs.
Out-patient Hos- 90 % of costs.
pital treatment

 KPT Versicherungen AG
KPT, Postfach, CH-3001 Bern
kpt.ch

Per day 1 to 90 days 90 to 180 days 181 to 720 days

Out-patient treat- Physiotherapy 90 % of costs, maximum 36 sessions per calendar year.
ment prescribed
Ergotherapy 90 % of costs, maximum 24 sessions per calendar year.
by a doctor
Speech therapy 90 % of costs, maximum 24 sessions per calendar year.
Nurse / nursing 90 % of costs, maximum CHF 2,000.– per calendar year.
auxiliary (Spitex)
Medicaments /  90 % of costs provided a doctor’s prescription is submitted.
Dressing material No costs are accepted for the following: Preventive medication; contracep-
(pharmacist) of tives; bathing, showering and washing preparations; chemical preparations
for the care contact lenses, sexual stimulants / restoratives; vitamin prepara-
tions; medicaments for the treatment of obesity; foods, diet products, artificial
sweeteners, articles consumed for stimulation / enjoyment, mineral water; hy-
gienic articles; homeopathic, phytotherapeutic, oligosolic and anthroposophic
medicaments, hair restorer.

Maternity CHF 150.– per birth toward prenatal courses.

CHF 100.– per birth toward postnatal gymnastics. A waiting period of
270 days is applied for these benefits.

Babies CHF 100.– contribution to babies insured under the Voluntary

Health Insurance plan.
Preventive gynaeco- 90 % of costs.
logical examination
Sterilisation /  90 % of costs, maximum CHF 300.–
vasectomy
Check-up 90 % of costs, maximum CHF 200.– per calendar year.
Exceptions: Check-ups required by employers, the Police Traffic Department,
insurance companies, authorities, government departments and institutions.

Transport 90 % of costs, maximum CHF 500.– within a 90 day period toward medically
necessary emergency transport to the nearest doctor or to the nearest hos­
pital or for transfer between hospitals.

Eye glasses /  CHF 200.– per calendar year for necessary spectacles or contact lenses pre-
contact lenses scribed by a doctor or an optician.
Apparatus 90 % of costs (for rent or purchase), maximum CHF 1,000.– per calendar year,
if the apparatus is prescribed by a doctor.
Laboratory analyses 90 % of costs.
Dental treatment 50 % of costs, maximum CHF 300.– per calendar year.
Spa cures CHF 10.– per day for a maximum of 21 days per calendar year
if a doctor’s prescription is submitted.

 KPT Versicherungen AG
KPT, Postfach, CH-3001 Bern
kpt.ch

Service providers F art. 4

1 The benefits in art. 3 are accepted if these are provided by individuals or institutions with the ne­

cessary training, recognition and authorisation. The following is a conclusive list of service providers:
doctors with a university degree in human medicine, chiropractors, physiotherapists, ergotherapists,
speech therapists, midwives, nurses and nursing auxiliaries, pharmacists, laboratories and hospitals.
2 Responsibility for proving that the service provider is duly recognised rests with the insured person.
3 Treatment in Switzerland is provided according to the stipulations of the FLHI (KVG).

Tariffs F art. 5
We pay compensation in accord with the customary local tariffs. Reduced payment will be made if ex-
cessively high bills are submitted.

Duration of benefits F art. 6

1 If in-patient treatment lasts longer than 720 days within a 900 day period no further benefits will be

paid.
2 If in-patient psychiatric treatment continues without an interruption of at least 90, or as the case may

be 180 days, the treatment is counted as one incident.

Obligations

Notification and verification F art. 7

Insurance claims must be made on the special «Declaration of Illness» form.

Administration

Addresses F art. 8
You have to provide an address in Switzerland for correspondence and payments (bank or postal ac-
count). All legally binding information pertaining to the insurance will be sent to the most recent address
available to us.

Legal venue F art. 9

The legal venue is Berne (Switzerland).

Berne, 31 July 2005

KPT Versicherungen AG

 KPT Versicherungen AG